ICU Chest Films > Fluid in the Chest > Congestive Heart Failure

Congestive Heart Failure

Cardogenic pulmonary edema is the result of left ventricular failure. Initially, increased filling volumes will increase contractility, as described by the Frank-Starling Curve. This mechanism though will fail if the ventricle is overstretched. The result is poor cardiac output and increased pulmonary venous hydrostatic pressures resulting in cardiogenic pulmonary edema. The combination of a weak heart and fluid overloading leads to congestive heart failure. Cardiac valvular disease, ischemic cardiomyopathy, renal failure and other causes may also lead to congestive heart failure. The chest radiograph plays an important role in distinguishing fluid overload or congestive failure causes before the onset of symptoms. Left-sided cardiac failure may be detected on a chest x-ray in 25-40% of patients in the event of an acute myocardial ischemia prior to clinical diagnosis. Under ideal situations, the chest film should be taken erect and in the PA view. Supine AP films reduce the viewers ability to detect cardiomegally and redistribution of pulmonary flow. Therefore, semierect and decubitus films are recommended in patients who may have new onset congestive heart failure.

What are the four most common causes of left-sided CHF?
Pulmonary embolism
Acute myocardial ischemia
Atrial septal defect
Ischemic cardiomyopathy
Valvular heart disease
Non-ischemic cardiomyopathy
Tricuspid regurgitation